社区失能老人孤独感对抑郁的影响:希望、自尊的并行中介作用

Effect of loneliness on depression in community disabled elderly:parallel mediation of hope and self-esteem

目的探究希望、自尊在社区失能老人孤独感与抑郁关系中的并行中介作用,为促进社区失能老人心理健康提供科学依据。方法2022年1月至5月,采取便利抽样法选取西安市西窑坊社区、电建社区、陕汽万寿社区、长乐西路社区、东窑坊社区5家与空军军医大学第一附属医院有延续性护理合作的社区中335例失能老人为研究对象,采用一般资料调查问卷、简版老年抑郁量表(GDS-15)、UCLA孤独感量表简化版(ULS-8)、Herth希望量表(HHI)和罗森伯格自尊量表(RSES)进行问卷调查。共发放问卷335份,有效回收325份,有效回收率为97%。采用Pearson相关分析进行各变量间相关性分析,应用Harman单因素检验法进行共同方法偏差检验,运用Hayes编制的宏程序PROCESS v4.0进行线性回归分析和Bootstrap分析。结果共有效调查325例社区失能老人,男180例,女145例,轻度失能232例,占71.4%;中度失能79例,占24.3%;重度失能14例,占4.3%。社区失能老人GDS-15、ULS-8、HHI和RSES量表得分分别为(6.16±3.89)、(16.41±5.44)、(34.09±6.66)、(29.58±5.32)分。相关性分析结果表明,孤独感与抑郁呈显著正相关,差异有统计学有意义(r=0.687,P<0.05),与希望、自尊呈显著负相关,差异均有统计学有意义(r=-0.694、-0.612,P<0.05);希望、自尊与抑郁呈显著负相关,差异均有统计学有意义(r=-0.755、-0.660,P<0.05)。中介效应分析结果显示,孤独感对抑郁的总效应值为0.490,95%CI为0.434~0.547;总中介效应值为0.291,95%CI为0.233~0.352,占总效应的59.39%,其中希望的中介效应值为0.216,95%CI为0.155~0.275,占总效应的44.08%,自尊的中介效应值为0.075,95%CI为0.049~0.225,占总效应的15.31%;孤独感对抑郁的直接效应值为0.199,95%CI为0.132~0.267,占总效应的40.61%。结论孤独感可以直接预测抑郁,也可以通过希望、自尊的并行中介作用间接预测抑郁。因此社区管理者应早期识别社区失能老人的孤独情绪,呼吁家人、社区乃至社会给予社区失能老人足够的陪伴、关心及支持,同时重视希望、自尊在降低抑郁方面的作用。

Objective To explore the parallel mediation role of hope and self-esteem between loneliness and depression of the disabled elderly in the community,and to provide scientific reference for promoting the mental health of them.Methods From January to May 2022,335 disabled elderly were selected by convenient sampling method from 5 communities in Xi′an,that had continuous care cooperation with First Affilicated Hospital,Air Force Medical University,including Xiyaofang Community,Dianjian Community,Shanqi Wanshou Community,Changle West Road Community and Dongyaofang Community.General information questionnaire,short form geriatric depression scale(GDS-15),short-form of the University of California,Los Angeles loneliness scale(ULS-8),Herth hope index(HHI)and Rosenberg self-esteem scale(RSES)were employed to conduct the questionnaire survey.A total 335 questionnaires were distributed,and 325 valid questionnaires were recovered,with the valid recovery rate of 97%.Pearson correlation analysis was applied to correlation analysis among variables,Harman single factor test was used for common method deviation test,and the PROCESS v4.0 developed by Hayes was used for linear regression analysis and Bootstrap analysis.Results A total of 325 elderly people with disabilities were effectively surveyed,180 males and 145 females,232 with mild disabilities,accounting for 71.4%;79 with moderate disabilities,accounting for 24.3%;and 14 with severe disabilities accounting for 4.3%.Scores on the GDS-15,ULS-8,HHI and RSES for the disabled elderly in the community were(6.16±3.89),(16.41±5.44),(34.09±6.66)and(29.58±5.32)points respectively.Correlation analysis showed that loneliness was positively correlated with depression,the difference was statistically significant(r=0.687,P<0.05),and was negatively correlated with hope and self-esteem,the differences were statistically significant(r=-0.694,-0.612;P<0.05).Hope and self-esteem were negatively correlated with depression,the differences were statistically significant(r=-0.755,-0.660;P<0.05).The mediating effect analysis showed that the total effect value of loneliness on depression was 0.490,95%CI was 0.434-0.547.The total mediating effect value was 0.291,95%CI was 0.233-0.352,accounting for 59.39%of the total effect.The mediating effect value of hope was 0.216,95%CI was 0.155-0.275,accounting for 44.08%of the total effect.The mediating effect value of self-esteem was 0.075,95%CI was 0.049-0.225,accounting for 15.31%of the total effect.The direct effect value of loneliness on depression was 0.199,95%CI was 0.132-0.267,accounting for 40.61%of the total effect.Conclusions Loneliness can directly predict depression,or it can indirectly predict depression through the parallel mediating role of hope and self-esteem.Community managers should therefore early identify the loneliness of the disabled elderly in the community and call for family,community and even society to give them adequate companionship,care and support,while valuing the role of hope and self-esteem in reducing depression.